Provider Demographics
NPI:1962541375
Name:SPRINGFIELD PSYCHIATRIC ASSOCIATES INC
Entity type:Organization
Organization Name:SPRINGFIELD PSYCHIATRIC ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRAMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELLANKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-342-9030
Mailing Address - Street 1:3162 EL CAMINO DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1318
Mailing Address - Country:US
Mailing Address - Phone:937-342-9030
Mailing Address - Fax:937-342-9039
Practice Address - Street 1:3162 EL CAMINO DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1318
Practice Address - Country:US
Practice Address - Phone:937-342-9030
Practice Address - Fax:937-342-9039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0002982104100000X, 1041C0700X
OH350630602084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9341501OtherMEDICARE
OH9341501Medicare PIN